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Wolie ZT, Roberts JA, Gilchrist M, McCarthy K, Sime FB. Current practices and challenges of outpatient parenteral antimicrobial therapy: a narrative review. J Antimicrob Chemother 2024; 79:2083-2102. [PMID: 38842523 PMCID: PMC11368434 DOI: 10.1093/jac/dkae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Extended hospitalization for infection management increases inpatient care costs and the risk of healthcare-associated adverse events, including infections. The growing global demand for healthcare, the diminishing availability of hospital beds and an increasing patient preference for care within their own home have been the primary drivers of the expansion of hospital-in-the-home programmes. Such programmes include the use of IV antimicrobials in outpatient settings, known as outpatient parenteral antimicrobial therapy (OPAT). However, OPAT practices vary globally. This review article aims to describe the current OPAT practices and challenges worldwide. OPAT practice begins with patient evaluation and selection using eligibility criteria, which requires collaboration between the interdisciplinary OPAT team, patients and caregivers. Depending on care requirements, eligible patients may be enrolled to various models of care, receiving medication by healthcare professionals at outpatient infusion centres, hospital clinics, home visits or through self-administration. OPAT can be used for the management of many infections where an effective oral treatment option is lacking. Various classes of parenteral antimicrobials, including β-lactams, aminoglycosides, glycopeptides, fluoroquinolones and antifungals such as echinocandins, are used globally in OPAT practice. Despite its benefits, OPAT has numerous challenges, including complications from medication administration devices, antimicrobial side effects, monitoring requirements, antimicrobial instability, patient non-adherence, patient OPAT rejection, and challenges related to OPAT team structure and administration, all of which impact its outcome. A negative outcome could include unplanned hospital readmission. Future research should focus on mitigating these challenges to enable optimization of the OPAT service and thereby maximize the documented benefits for the healthcare system, patients and healthcare providers.
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Affiliation(s)
- Zenaw T Wolie
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30029 Nîmes, France
| | - Mark Gilchrist
- Department of Pharmacy/Infection, Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Diseases, Imperial College, London, UK
| | - Kate McCarthy
- Royal Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Infectious Diseases, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Fekade B Sime
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
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van der Merwe SM, Boyd N, Mavhunga S. Stability of intravenous medicines - evidence of maximum temperature reached in both summer and winter within soft shell elastomeric pumps. Eur J Hosp Pharm 2024:ejhpharm-2024-004276. [PMID: 39174293 DOI: 10.1136/ejhpharm-2024-004276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVE Elastomeric devices or pumps are a valuable tool to deliver outpatient parenteral therapy and have been used for administration of chemotherapy, antibiotics and pain medication. A key determinant of effective treatment is to consider the stability of medicines within these devices. It is widely known that an increase in temperature positively correlates to an increase in drug degradation. The objective of our work was to measure the temperature within soft shell elastomeric devices, under simulated outpatient treatment conditions in summer and winter months, and to determine the maximum temperature reached within these periods of use. METHODS Thermocouples were inserted within soft shell Easypump II (B Braun Medical, Sheffield, UK) elastomeric pumps and the temperature was monitored under simulated outpatient conditions during cold and warm weather with different fill volumes. Temperature monitoring was also conducted with varying levels of insulation around the devices. RESULTS Our results show that internal temperatures remained below 32°C±1°C in winter and summer months, including during times defined as a heatwave. Fill volume and ambient temperature were shown to be significant factors affecting the internal temperatures reached. CONCLUSION A soft shell Easypump II elastomeric pump, if used within its carry pouch, will maintain the internal solution below a temperature of 32°C±1°C if patients correctly adhere to handling guidance. Our results show that further improvements to the insulation material used in carry pouches can significantly restrict the rate of temperature rise within the pumps and will give more assurance in relation to preventing degradation especially considering the increases in extreme weather conditions observed in recent years due to global warming.
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Affiliation(s)
- Susanna Maria van der Merwe
- School of Medicine, Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Nicholas Boyd
- School of Medicine, Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
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Reidy P, Breslin T, Muldoon E. Outpatient parenteral antimicrobial therapy (OPAT) across the world: a comparative analysis-what lessons can we learn? JAC Antimicrob Resist 2024; 6:dlae111. [PMID: 39035018 PMCID: PMC11258576 DOI: 10.1093/jacamr/dlae111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
This paper presents a comparative analysis of Outpatient Parenteral Antimicrobial Therapy (OPAT) structures and delivery options across different countries. OPAT, a cost-effective alternative to inpatient care for patients requiring IV antimicrobial therapy, has demonstrated multiple benefits such as patient satisfaction, economic cost savings, and reduced hospital-acquired infections. Despite these advantages, there is considerable international variation in OPAT use and implementation. By examining the OPAT structures of multiple countries, we aim to identify areas of variation and explore opportunities for expansion and improvement of OPAT services.
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Affiliation(s)
- Paul Reidy
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Tara Breslin
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Eavan Muldoon
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- National OPAT Programme, Health Services Executive, Dublin, Ireland
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Seaton RA, Gilchrist M. Making a case for outpatient parenteral antimicrobial therapy (OPAT). J Antimicrob Chemother 2024; 79:1723-1724. [PMID: 38874182 DOI: 10.1093/jac/dkae183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
In the wake of the COVID-19 pandemic, and its negative impact on both acute and elective care and decline in available inpatient resources, there is an imperative to maximize safe and effective alternatives to inpatient hospital care. Properly governed outpatient parenteral antimicrobial therapy (OPAT) services embed the principles of antimicrobial stewardship (AMS) (including use of early oral therapy) and support admission avoidance and early discharge for a growing range of patient groups with complex infections through well-organized multidisciplinary team working. Expansion of OPAT aligns with the UK's national strategy to deliver care closer to home and cost-effectively maximize use of inpatient resources. OPAT serves as an exemplar to other ambulatory services and presents opportunities for developing and assuring AMS strategies within the rapidly developing hospital-at-home and virtual ward environments.
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Affiliation(s)
- R A Seaton
- NHS Greater Glasgow and Clyde, Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - M Gilchrist
- Department of Infection/Pharmacy, Imperial College Healthcare NHS Trust, London, UK
- University Department of Infection, Imperial College, London, UK
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5
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Schmidt-Hellerau K, Baade N, Günther M, Scholten N, Lindemann CH, Leisse C, Oberröhrmann C, Peter S, Jung N, Suarez I, Horn C, Ihle P, Küpper-Nybelen J, Hagemeier A, Hellmich M, Lehmann C. Outpatient parenteral antimicrobial therapy (OPAT) in Germany: insights and clinical outcomes from the K-APAT cohort study. Infection 2024; 52:1407-1414. [PMID: 38478255 PMCID: PMC11289149 DOI: 10.1007/s15010-024-02199-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Outpatient parenteral antimicrobial therapy (OPAT) offers several key advantages, including enhanced patient quality of life, reduced healthcare costs, and a potential reduction of nosocomial infections. It is acknowledged for its safety and effectiveness. This study provides the first systematic clinical data for Germany, where OPAT has not yet been widely adopted. The aim is to establish a foundational reference point for further research and integration of OPAT into the German healthcare system. METHODS This prospective observational study descriptively analyses data obtained from a cohort of patients receiving OPAT. Both in- and outpatients from all medical specialties could be recruited. Patients administered the anti-infective medications themselves at home using elastomeric pumps. RESULTS 77 patients received OPAT, with a median duration of 15 days and saving 1782 inpatient days. The most frequently treated entities were orthopaedic infections (n = 20, 26%), S. aureus bloodstream infection (n = 16, 21%) and infectious endocarditis (n = 11, 14%). The most frequently applied drugs were flucloxacillin (n = 18, 23%), penicillin G (n = 13, 17%) and ceftriaxone (n = 10; 13%). Only 5% of patients (n = 4) reported to have missed more than one outpatient dose (max. 3 per patient). Only one catheter-related adverse event required medical intervention, and there were no catheter-related infections. CONCLUSION The study demonstrates that OPAT can be safely conducted in Germany. In preparation for its broader implementation, crucial next steps include creating medical guidelines, fostering interdisciplinary and inter-sectoral communication, as well as creating financial and structural regulations that facilitate and encourage the adoption of OPAT. TRIAL REGISTRATION NUMBER NCT04002453.
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Affiliation(s)
- Kirsten Schmidt-Hellerau
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nina Baade
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Marina Günther
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Heinrich Lindemann
- Department II of Internal Medicine and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Charlotte Leisse
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Charlotte Oberröhrmann
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sophie Peter
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Norma Jung
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Isabelle Suarez
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Carola Horn
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Peter Ihle
- PMV Forschungsgruppe, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jutta Küpper-Nybelen
- PMV Forschungsgruppe, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna Hagemeier
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Clara Lehmann
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.
- German Center for Infection Research (DZIF), Bonn-Cologne, Germany.
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6
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Brand H, Fryer M, Mehdi AM, Melon A, Morcombe B, Choong K, Subedi S. Home nursing and self-administered outpatient parenteral antimicrobial treatment: a comparison of demographics and outcomes from a large regional hospital in Queensland, Australia. Intern Med J 2024; 54:1351-1359. [PMID: 38591847 DOI: 10.1111/imj.16394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/15/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Outpatient parenteral antimicrobial treatment (OPAT) is a safe and effective therapy used in several settings across Australia. As OPAT services expand their inclusion criteria to include complex patient populations, there is an increased need for selecting appropriate patients to receive either healthcare-administered OPAT (H-OPAT) or self-administered OPAT (S-OPAT). AIMS To describe patient demographics, diagnosis, microbiology and outcomes of patients treated by H-OPAT and S-OPAT within the Sunshine Coast Hospital and Health Service, Australia. METHODS Data on demographics, diagnoses, treatment and outcomes on all patients treated by H-OPAT and S-OPAT from March 2017 to December 2019 were collected retrospectively. RESULTS One hundred and sixty-five patients (62.26%) were enrolled in H-OPAT and 100 patients (37.74%) in S-OPAT. S-OPAT patients were significantly younger. H-OPAT patients were more comorbid. Bone and joint infections were the most treated infections and were more likely to be treated by S-OPAT. There was no difference in treatment duration, cure and complication rates between S-OPAT and H-OPAT. Longer duration of therapy was associated with more complications. Treatment failure was associated with infections due to multiple organisms, number of comorbidities and treatment of surgical site, skin and soft tissue infections. CONCLUSIONS There were significant differences in demographics between H-OPAT and S-OPAT without any difference in outcomes. Overall failure and complication rates were low. Higher rates of treatment failure were predicted by the diagnosis, number of comorbidities and number of organisms treated.
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Affiliation(s)
- Holly Brand
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
| | - Michael Fryer
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Ahmed M Mehdi
- QCIF Bioinformatics, Queensland Cyber Infrastructure Foundation Ltd, Brisbane, Queensland, Australia
| | - Alex Melon
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Bridie Morcombe
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Keat Choong
- Infectious Diseases Department, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
- Infection Research Network, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia
| | - Shradha Subedi
- Infectious Diseases Department, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
- Infection Research Network, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia
- Microbiology, Pathology Queensland, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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7
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Metsä-Simola N, Saarenketo J, Lehtonen H, Broman N, Häggblom T, Björklöf P, Sariola S, Valta MP. Guidelines to practice in hospitals at home: safe and effective continuous infusion pumps substantially increased penicillin use in erysipelas treatment. Eur J Public Health 2024:ckae112. [PMID: 38996407 DOI: 10.1093/eurpub/ckae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
Hospitals at home are increasingly offering outpatient parenteral antimicrobial therapy (OPAT) in an attempt to reduce costly inpatient care, but these settings favour broad-spectrum antibiotics that require less frequent dosing than penicillin. Benzyl penicillin could be delivered via continuous infusion pumps (eCIPs), but studies on their safety and efficacy in OPAT are scarce, and it remains unclear how much the availability of eCIPs increases penicillin use in real-life settings. We examined 462 electronic healthcare records of erysipelas patients treated between January 2018 and January 2022 in a large Finnish OPAT clinic. Average marginal effects from logistic models were estimated to assess how the introduction of eCIPs in December 2020 affected penicillin use and to compare clinical outcomes between patients with and without eCIPs. Introduction of eCIPs increased the predicted probability of penicillin treatment by 36.0 percentage points (95% confidence interval 25.5-46.5). During eCIP implementation, patients who received an eCIP had 73.1 (58.0-88.2) percentage points higher probability than patients without an eCIP to receive penicillin treatment. They also had about 20 percentage points higher probability to be cured at the time of discharge and 3 months after it. Patient and nurse satisfaction regarding eCIPs was very high. Benzyl penicillin eCIP treatment is effective and safe, and substantially increases the use of penicillin instead of broad-spectrum antibiotics. To reduce the risk of antimicrobial resistance, eCIPs could increasingly be promoted for use in OPAT clinics, and there should be adequate education and support in their implementation.
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Affiliation(s)
- Niina Metsä-Simola
- Helsinki Institute for Demography and Population Health, University of Helsinki, Helsinki, Finland
- Max Planck, University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Jenni Saarenketo
- Turku City Hospital OPAT Clinic, The Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Henri Lehtonen
- Turku City Hospital OPAT Clinic, The Wellbeing Services County of Southwest Finland, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Niklas Broman
- Turku City Hospital OPAT Clinic, The Wellbeing Services County of Southwest Finland, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Tony Häggblom
- Turku City Hospital Department of Infectious Diseases, The Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Pia Björklöf
- Turku City Hospital OPAT Clinic, The Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Salla Sariola
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Maija P Valta
- Turku City Hospital OPAT Clinic, The Wellbeing Services County of Southwest Finland, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
- Department of Hematology and Stem Cell Transplantation, Turku University Hospital, The Wellbeing Services County of Southwest Finland, Turku, Finland
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Soni S, Harding I, Jones C, Wade S, Norton J, Pollock JS. A Qualitative Review of Patient Feedback for the OPAT (Outpatient Antimicrobial Therapy) Service in Bristol. Antibiotics (Basel) 2024; 13:420. [PMID: 38786148 PMCID: PMC11117369 DOI: 10.3390/antibiotics13050420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) aims to deliver intravenous antimicrobials to medically stable patients with complex infections outside of a hospital setting. There is good evidence to demonstrate the safety and efficacy of OPAT in the literature. Anecdotally, the feedback from patients has been positive, but only a few studies evaluate this topic in detail. The aim of this qualitative study was to examine patients' experiences with and feedback on the OPAT service in Bristol, United Kingdom, which was established in 2021. A total of 92 patient feedback surveys were reviewed retrospectively, and thematic analysis was undertaken. Feedback from OPAT patients in our centre was overwhelmingly positive. The key themes identified were benefits to the patients, their friends, and family, and positive feedback about OPAT staff. The mean overall satisfaction score for OPAT was 9.6 out of 10. Areas to improve included communication between the OPAT and parent teams, improving OPAT capacity, and expansion of the service.
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Affiliation(s)
- Shuchita Soni
- Department of Infectious Diseases, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK
| | - Irasha Harding
- Department of Microbiology, Bristol Royal Infirmary, Marlborough Street, Bristol BS1 3NU, UK;
| | - Carys Jones
- Department of Pharmacy, Bristol Royal Infirmary, Marlborough Street, Bristol BS1 3NU, UK; (C.J.); (S.W.); (J.N.)
| | - Sue Wade
- Department of Pharmacy, Bristol Royal Infirmary, Marlborough Street, Bristol BS1 3NU, UK; (C.J.); (S.W.); (J.N.)
| | - Jenna Norton
- Department of Pharmacy, Bristol Royal Infirmary, Marlborough Street, Bristol BS1 3NU, UK; (C.J.); (S.W.); (J.N.)
| | - Jennifer Siobhan Pollock
- Sirona Care and Health CIC, Second Floor, Kingswood Civic Centre, High Street, Kingswood, Bristol BS15 9TR, UK;
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Schwiebert DR, Atanze DS, Iroegbu DU, Wilkins DM, Sandoe DJAT. Outpatient parenteral antibiotic treatment for infective endocarditis: A retrospective observational evaluation. Clin Med (Lond) 2024; 24:100213. [PMID: 38643831 PMCID: PMC11101910 DOI: 10.1016/j.clinme.2024.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/23/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Infective endocarditis (IE) requires long courses of intravenous (IV) antibiotics. Outpatient parenteral antibiotic therapy (OPAT) saves resources, improves the patient experience and allows care in their preferred place; however, questions remain about safety when treating IE patients. This study evaluates OPAT management of IE patients in our region between 2006 and 2019. METHODS This is a retrospective observational evaluation and description of outcomes and adherence to suitability criteria, according to British Society for Antimicrobial Chemotherapy (BSAC) guidelines. RESULTS We identified five models of OPAT delivery. The number of patients treated expanded significantly over time. Of 101 patients, six (6%) suffered poor outcomes, but each patient had contributing factors outside of the primary infection. Median OPAT duration was 12 days and 1,489 hospital bed days were saved. CONCLUSIONS In a setting where there was good adherence to BSAC criteria, treating IE patients using OPAT services was safe. Complications observed were likely independent of treatment location. Significant bed days were saved.
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Affiliation(s)
- Dr Ralph Schwiebert
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom.
| | - Dr Sokolayam Atanze
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom
| | - Dr Uchechika Iroegbu
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom
| | - Dr Molly Wilkins
- Department of Anaesthesia and Intensive Care Medicine, Countess of Chester Hospital, Chester, England, United Kingdom
| | - Dr Jonathan A T Sandoe
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom; Leeds Institute of Medical Research, University of Leeds, Leeds, England, United Kingdom
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10
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Mohammed SA, Cotta MO, Assefa GM, Erku D, Sime F. Barriers and facilitators for the implementation and expansion of outpatient parenteral antimicrobial therapy: a systematic review. J Hosp Infect 2024; 147:1-16. [PMID: 38423135 DOI: 10.1016/j.jhin.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) has been expanding in recent years and serves as a viable solution in reducing the shortage of hospital beds. However, the wider implementation of OPAT faces numerous challenges. This review aimed to assess implementation barriers and facilitators of OPAT services. Studies describing barriers and facilitators of the OPAT service were retrieved from PubMed, Scopus, MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science Proceedings, International Pharmaceutical Abstracts and PsycINFO. All types of study designs published in the English language were included. Studies that did not mention any barrier or facilitator, did not differentiate OPAT and inpatient, focused on specific antimicrobials or diseases, and made no distinction between parenteral and other treatments were excluded. Qualitative analysis was performed using the 'best-fit' framework approach and the Consolidated Framework for Implementation Research (CFIR). The review was PROSPERO registered (CRD42023441083). A total of 8761 studies were screened for eligibility and 147 studies were included. Problems in patient selection, lack of awareness, poor communication and co-ordination, lack of support, lack of structured service and inappropriate prescriptions were identified. OPAT provides safe, effective and efficient treatment while maintaining patients' privacy and comfort, resulting in less daily life disruption, and reducing the risk of infection. Satisfaction and preference for OPAT were very high. Initiatives in strengthening OPAT such as antimicrobial stewardship and telemedicine are beneficial. Challenges to and facilitators of OPAT were identified among patients, health professionals, OPAT service providers and healthcare administrators. Understanding them is crucial to designing targeted initiatives for successful OPAT service implementation.
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Affiliation(s)
- S A Mohammed
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - M O Cotta
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
| | - G M Assefa
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - D Erku
- Centre for Applied Health Economics, Griffith University, Nathan, Australia
| | - F Sime
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
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11
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Canterino J, Malinis M, Liu J, Kashyap N, Brandt C, Justice A. Creation and Validation of an Automated Registry for Outpatient Parenteral Antibiotics. Open Forum Infect Dis 2024; 11:ofae004. [PMID: 38412514 PMCID: PMC10866572 DOI: 10.1093/ofid/ofae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/08/2024] [Indexed: 02/29/2024] Open
Abstract
Existing outpatient parenteral antibiotic therapy (OPAT) registries are resource intensive, and OPAT programs struggle to produce objective data to show the value of their work. We describe the building and validation of an automated OPAT registry within our electronic medical record and provide objective data on the value of the program. Variables and outcomes include age, sex, race, ethnicity, primary insurance payor, antibiotic names, infection syndromes treated, discharge disposition, 30-day all-cause readmission and death rates, complications, and an estimate of the hospital days saved. Records for 146 OPAT episodes were reviewed manually to validate the registry. Data were displayed in a dashboard within the electronic medical record. Over the 4-year time frame, our registry collected 3956 unique patients who completed 4710 episodes (approximately 1200 episodes per year). A total of 400 complications during OPAT were identified. All variables had an accuracy of >90% on validation. The OPAT program resulted in a reduction in hospital length of stay by 88 820 days, or roughly 22 000 days per year. We intend our registry to serve as a blueprint for similar OPAT programs with limited administrative resources. Wider application of our system would allow for easier aggregation and comparisons of OPAT practice and address the lack interinstitutional standardization of OPAT data and outcomes.
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Affiliation(s)
| | - Maricar Malinis
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jing Liu
- Yale–New Haven Health, New Haven, Connecticut, USA
| | - Nitu Kashyap
- Yale University School of Medicine, New Haven, Connecticut, USA
- Yale–New Haven Health, New Haven, Connecticut, USA
| | - Cynthia Brandt
- Veterans Affairs Heathcare System, West Haven CT; Yale University School of Medicine, New Haven, Connecticut, USA
| | - Amy Justice
- Veterans Affairs Heathcare System, West Haven CT; Yale University School of Medicine, New Haven, Connecticut, USA
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Bolton WJ, Wilson R, Gilchrist M, Georgiou P, Holmes A, Rawson TM. Personalising intravenous to oral antibiotic switch decision making through fair interpretable machine learning. Nat Commun 2024; 15:506. [PMID: 38218885 PMCID: PMC10787786 DOI: 10.1038/s41467-024-44740-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
Antimicrobial resistance (AMR) and healthcare associated infections pose a significant threat globally. One key prevention strategy is to follow antimicrobial stewardship practices, in particular, to maximise targeted oral therapy and reduce the use of indwelling vascular devices for intravenous (IV) administration. Appreciating when an individual patient can switch from IV to oral antibiotic treatment is often non-trivial and not standardised. To tackle this problem we created a machine learning model to predict when a patient could switch based on routinely collected clinical parameters. 10,362 unique intensive care unit stays were extracted and two informative feature sets identified. Our best model achieved a mean AUROC of 0.80 (SD 0.01) on the hold-out set while not being biased to individuals protected characteristics. Interpretability methodologies were employed to create clinically useful visual explanations. In summary, our model provides individualised, fair, and interpretable predictions for when a patient could switch from IV-to-oral antibiotic treatment. Prospectively evaluation of safety and efficacy is needed before such technology can be applied clinically.
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Affiliation(s)
- William J Bolton
- Centre for Antimicrobial Optimisation, Imperial College London, London, UK.
- AI4Health Centre for Doctoral Training, Imperial College London, London, UK.
- Department of Computing, Imperial College London, London, UK.
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
| | - Richard Wilson
- Centre for Antimicrobial Optimisation, Imperial College London, London, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - Mark Gilchrist
- Centre for Antimicrobial Optimisation, Imperial College London, London, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Pantelis Georgiou
- Centre for Antimicrobial Optimisation, Imperial College London, London, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Centre for Bio-inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Alison Holmes
- Centre for Antimicrobial Optimisation, Imperial College London, London, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Timothy M Rawson
- Centre for Antimicrobial Optimisation, Imperial College London, London, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
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Jenkins A, Jamieson C, Santillo M. Systematic review of room temperature stability of key beta-lactam antibiotics for extended infusions in inpatient settings. Eur J Hosp Pharm 2023; 31:2-9. [PMID: 37848286 PMCID: PMC11148869 DOI: 10.1136/ejhpharm-2023-003855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Extended infusion (EI) of beta-lactam antibiotics may offer clinical benefits aligned with improved probability of target attainment for critical pharmacokinetic/pharmacodynamic parameters that correlate with efficacy. There is much research interest in prolonged and continuous infusions (collectively, extended infusions) of beta-lactams to improve patient outcomes, particularly in critically ill patients in intensive care. While definitive clinical trial data demonstrating beneficial outcomes is awaited, there has been limited focus on the stability of the agents given by EI, which may be an equally critical parameter. EI may allow for savings in nursing time due to reduced need for drug reconstitution. We set out to examine the data for stability for EI at room temperature, consistent with the requirements of 'A Standard Protocol for Deriving and Assessment of Stability- Part 1 Aseptic Preparation (Small Molecules)', which allows a 5% loss of active pharmaceutical ingredient (API) applicable for those territories that use the British Pharmacopoeia also for a 10% loss applicable in much of rest of the world. METHODS Searches using preferred reporting items for systematic reviews and meta-analyses (PRISMA) principles for stability data on freshly prepared beta-lactam antimicrobials for extended administration at room temperature (at or above 23°C) were conducted in November 2021 and updated in December 2022. RESULTS We found data to support the extension of the shelf life of 12 key beta-lactam antibiotics once reconstituted (aztreonam, amoxicillin, benzylpenicillin, flucloxacillin, piperacillin/tazobactam, cefazolin, cefmetazole, ceftaroline, ceftazidime, ceftriaxone, imipenem and meropenem) compliant with the NHS protocol, and data for five other agents (ticarcillin, cefepime, cefiderocol, cefoxitin and doripenem) which would be acceptable in regions outside the UK beyond that listed in the Summary of Product Characteristics.This review has not been registered under PROSPERO.
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Affiliation(s)
- Abi Jenkins
- Pharmacy, University Hospitals Birmingham, Birmingham, UK
| | | | - Mark Santillo
- UK and University Hospitals Bristol and Weston NHS Trust, Plymouth Bristol, UK
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14
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Stubbs RD, Shorten RJ, Benedetto V, Muir A. Does comorbidity index predict OPAT readmission? JAC Antimicrob Resist 2023; 5:dlad125. [PMID: 38021037 PMCID: PMC10667028 DOI: 10.1093/jacamr/dlad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives To determine if the Charlson comorbidity index (CCI) is an accurate predictor of unplanned readmissions for patients using outpatient parenteral antimicrobial therapy (OPAT) services. Methods Retrospective analysis of patients >16 years of age who had received OPAT at Lancashire Teaching Hospitals between 2019 and 2021. The number of unplanned hospitalizations was measured and categorized as OPAT related or non-OPAT related. The CCI for each patient group was calculated using an online tool, and logistic regression was used to assess the association between risk factors and risk of being readmitted. Results The cohort consisted of 741 patients. Unplanned readmission was seen in 112 patients (15.1%). The mean CCI score for patients with OPAT-related readmissions was 4.22, 0.92 higher than the mean for patients who were not readmitted (3.30). The mean CCI score for patients with non-OPAT-related readmissions was higher still at 4.89. The logistic regression showed that increased CCI, age, male gender and home location compared with clinic were associated with increased odds of readmission, although these effects did not meet statistical significance. Conclusions These results suggest that a higher CCI score is associated with a non-statistically significant increased risk of unplanned hospitalization. We concluded that the CCI may therefore be used in future decision-making regarding the acceptance of patients to OPAT and requires further investigation.
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Affiliation(s)
- Ryan D Stubbs
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Robert J Shorten
- Department of Microbiology, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston PR2 9HT, UK
| | - Valerio Benedetto
- Applied Health Research hub, University of Central Lancashire, Victoria Street, Preston PR1 2HE, UK
| | - Alison Muir
- Department of Microbiology, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston PR2 9HT, UK
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15
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Sendi P, Lora-Tamayo J, Cortes-Penfield NW, Uçkay I. Early switch from intravenous to oral antibiotic treatment in bone and joint infections. Clin Microbiol Infect 2023; 29:1133-1138. [PMID: 37182643 DOI: 10.1016/j.cmi.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES The timing of the switch from intravenous (i.v.) to oral antibiotic therapy for orthopaedic bone and joint infections (BJIs) is debated. In this narrative article, we discuss the evidence for and against an early switch in BJIs. DATA SOURCES We performed a PubMed and internet search investigating the association between the duration of i.v. treatment for BJI and remission of infection among adult orthopaedic patients. CONTENT Among eight randomized controlled trials and multiple retrospective studies, we failed to find any minimal duration of postsurgical i.v. therapy associated with clinical outcomes. We did not find scientific data to support the prolonged use of i.v. therapy or to inform a minimal duration of i.v. THERAPY Growing evidence supports the safety of an early switch to oral medications once the patient is clinically stable. IMPLICATIONS After surgery for BJI, a switch to oral antibiotics within a few days is reasonable in most cases. We recommend making the decision on the time point based on clinical criteria and in an interdisciplinary team at the bedside.
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Affiliation(s)
- Parham Sendi
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
| | - Jaime Lora-Tamayo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 'i+12' Hospital 12 de Octubre, Madrid, Spain; CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ilker Uçkay
- Infectiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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16
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Hamilton RA, Courtenay M, Frost KJ, Harrison R, Root H, Allison DG, Tonna AP, Ashiru-Oredope D, Aldeyab MA, Shemilt K, Martin SJ. Implementation of the national antimicrobial stewardship competencies for UK undergraduate healthcare professional education within undergraduate pharmacy programmes: a survey of UK schools of pharmacy. JAC Antimicrob Resist 2023; 5:dlad095. [PMID: 37560542 PMCID: PMC10409409 DOI: 10.1093/jacamr/dlad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Pharmacists play a key role in antimicrobial stewardship (AMS). Consensus-based national AMS competencies for undergraduate healthcare professionals in the UK reflect the increasing emphasis on competency-based healthcare professional education. However, the extent to which these are included within undergraduate pharmacy education programmes in the UK is unknown. OBJECTIVES To explore which of the AMS competencies are delivered, including when and at which level, within UK undergraduate MPharm programmes. METHODS A cross-sectional online questionnaire captured the level of study of the MPharm programme in which each competency was taught, the method of delivery and assessment of AMS education, and examples of student feedback. RESULTS Ten institutions completed the survey (33% response rate). No institution reported covering all 54 AMS competencies and 5 of these were taught at half or fewer of the institutions. Key gaps were identified around taking samples, communication, outpatient parenteral antimicrobial therapy and surgical prophylaxis. The minimum time dedicated to AMS teaching differed between institutions (range 9-119 h), teaching was generally through didactic methods, and assessment was generally through knowledge recall and objective structured clinical examinations. Feedback from students suggests they find AMS and antimicrobial resistance (AMR) to be complex yet important topics. CONCLUSIONS UK schools of pharmacy should utilize the competency framework to identify gaps in their AMS, AMR and infection teaching. To prepare newly qualified pharmacists to be effective at delivering AMS and prescribing antimicrobials, schools of pharmacy should utilize more simulated environments and clinical placements for education and assessment of AMS.
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Affiliation(s)
- Ryan A Hamilton
- School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK
| | - Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, Wales
| | - Kevin J Frost
- Pharmacy Department, Airedale NHS Foundation Trust, Keighley BD20 6TD, UK
| | - Roger Harrison
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PT, UK
| | - Helen Root
- School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK
| | - David G Allison
- Division of Pharmacy & Optometry, The University of Manchester, Manchester M13 9PT, UK
| | - Antonella P Tonna
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen AB10 7AQ, UK
| | - Diane Ashiru-Oredope
- School of Pharmacy, University College London, London WC1N 1AX, UK
- UK Health Security Agency, London SW1P 3JR, UK
| | - Mamoon A Aldeyab
- Department of Pharmacy, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Katherine Shemilt
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Sandra J Martin
- School of Pharmacy & Medical Sciences, University of Bradford, Bradford BD7 1DP, UK
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17
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Venuti F, Gaviraghi A, De Nicolò A, Stroffolini G, Longo BM, Di Vincenzo A, Ranzani FA, Quaranta M, Romano F, Catellani E, Marchiaro C, Cinnirella G, D'Avolio A, Bonora S, Calcagno A. Real-Life Experience of Continuously Infused Ceftolozane/Tazobactam in Patients with Bronchiectasis and Multidrug-Resistant Pseudomonas aeruginosa Infection in the Outpatient Setting. Antibiotics (Basel) 2023; 12:1214. [PMID: 37508309 PMCID: PMC10376517 DOI: 10.3390/antibiotics12071214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Ceftolozane/tazobactam (C/T) is a novel β-lactam/β-lactamase inhibitor with excellent activity against the multidrug-resistant (MDR) P. aeruginosa. Continuous infusion (CI) dosing allows the optimization of pharmacokinetic and pharmacodynamic (PK/PD) properties of β-lactam antibiotics and may support patients' treatment as outpatients. (2) Methods: Adult patients receiving their entire course of C/T as a CI in the outpatient setting were retrospectively included in the study. The primary outcome evaluated was clinical resolution. The secondary outcomes evaluated were PK/PD target attainment (ƒT > 4 × MIC) and microbiologic clearance at the end of treatment. Therapeutic drug monitoring to assess C/T concentration was performed. (3) Results: Three patients were enrolled in the study and received 9 g of C/T in CI every 24 h. One patient received an additional course of antimicrobial therapy due to disease exacerbation six months after initial treatment, accounting for four evaluated treatments. The primary outcome was achieved in 3/4 treatments and the secondary outcome was achieved in 4/4 and 3/3, respectively. In all patients, free ceftolozane concentrations were >10 times higher than the EUCAST breakpoint (4 mg/L). (4) Conclusions: Elastomeric infusion of C/T delivered in CI can be an effective and convenient way to treat acute diseases caused by MDR-P. aeruginosa, avoid hospital admission, and contribute to infection control strategies. Despite the small number of enrolled patients, clinical and microbiological results support this strategy.
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Affiliation(s)
- Francesco Venuti
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Corso Svizzera 164, 10149 Torino, Italy
| | - Alberto Gaviraghi
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Corso Svizzera 164, 10149 Torino, Italy
| | - Amedeo De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, 10149 Turin, Italy
| | - Giacomo Stroffolini
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, 5, 37024 Verona, Italy
| | - Bianca Maria Longo
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Corso Svizzera 164, 10149 Torino, Italy
| | - Alessia Di Vincenzo
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, 10149 Turin, Italy
| | - Fabio Antonino Ranzani
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Corso Svizzera 164, 10149 Torino, Italy
| | - Matilde Quaranta
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Corso Svizzera 164, 10149 Torino, Italy
| | - Francesca Romano
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Corso Svizzera 164, 10149 Torino, Italy
| | - Eleonora Catellani
- ASL Città di Torino, Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Torino, Italy
| | - Carlotta Marchiaro
- ASL Città di Torino, Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Torino, Italy
| | - Giacoma Cinnirella
- ASL Città di Torino, Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Torino, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, 10149 Turin, Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Corso Svizzera 164, 10149 Torino, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Corso Svizzera 164, 10149 Torino, Italy
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18
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Childs-Kean LM, Beieler AM, Coroniti AM, Cortés-Penfield N, Keller SC, Mahoney MV, Rajapakse NS, Rivera CG, Yoke LH, Ryan KL. A Bundle of the Top 10 OPAT Publications in 2022. Open Forum Infect Dis 2023; 10:ofad283. [PMID: 37323428 PMCID: PMC10264063 DOI: 10.1093/ofid/ofad283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/19/2023] [Indexed: 06/17/2023] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) has become more common in clinical settings. Correspondingly, OPAT-related publications have also increased; the objective of this article was to summarize clinically meaningful OPAT-related publications in 2022. Seventy-five articles were initially identified, with 54 being scored. The top 20 OPAT articles published in 2022 were reviewed by a group of multidisciplinary OPAT clinicians. This article provides a summary of the "top 10" OPAT publications of 2022.
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Affiliation(s)
- Lindsey M Childs-Kean
- Correspondence: Lindsey M. Childs-Kean, PharmD, MPH, University of Florida, 1225 Center Drive, Gainesville, FL 32610 ()
| | - Alison M Beieler
- Infectious Diseases Clinic, Harborview Medical Center, Seattle, Washington, USA
| | - Ann-Marie Coroniti
- Department of Pharmacy, Infectious Diseases and Immunology Center, The Miriam Hospital, Providence, Rhode Island, USA
| | - Nicolás Cortés-Penfield
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sara C Keller
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Monica V Mahoney
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nipunie S Rajapakse
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic Children’s Center, Rochester, Minnesota, USA
| | | | - Leah H Yoke
- Vaccine and Infectious Disease Division, Fred Hutch Cancer Research Center, Allergy and Infectious Disease Division, University of Washington, Seattle, Washington, USA
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19
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Lai T, Thiele H, Rogers BA, Hillock N, Adhikari S, McNamara A, Rawlins M. Exploring the advancements of Australian OPAT. Ther Adv Infect Dis 2023; 10:20499361231199582. [PMID: 37745256 PMCID: PMC10515521 DOI: 10.1177/20499361231199582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) in Australia has evolved from modest beginnings to a well-established health service with proven benefits in patient outcomes. This is a comprehensive review of the current state of art Australian OPAT with vignettes of the types of OPAT models of care, antimicrobial prescribing and antimicrobial use. In addition, we highlight the similarities and differences between OPAT to other countries and describe Australian OPAT experiences with COVID-19 and paediatrics. Australian OPAT continues to advance with OPAT antifungals, novel treatment options and upcoming high-impact research.
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Affiliation(s)
- Tony Lai
- The University of Sydney School of Pharmacy, Bank Building - The University Of Sydney, 3 Parramatta Rd, Camperdown NSW 2050, Australia
| | - Horst Thiele
- Hospital in the Home, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Benjamin A. Rogers
- Monash University School of Clinical Sciences at Monash Health, Clayton, VIC, Australia
- Hospital in the Home program, Monash Health, Clayton, VIC, Australia
| | - Nadine Hillock
- National Antimicrobial Utilisation Surveillance Program, South Australia Health, Adelaide, SA, Australia
| | - Suman Adhikari
- Department of Pharmacy, St George Hospital, Kogarah, NSW, Australia
- School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
| | | | - Matthew Rawlins
- Department of Pharmacy, Fiona Stanley Hospital, Murdoch, WA, Australia
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20
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Shakoor S, Durojaiye OC, Collini PJ. Outcomes of outpatient parenteral antimicrobial therapy (OPAT) for urinary tract infections – A single center retrospective cohort study. CLINICAL INFECTION IN PRACTICE 2023. [DOI: 10.1016/j.clinpr.2022.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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21
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Stoorvogel HH, Hulscher MEJL, Wertheim HFL, Yzerman EPF, Scholing M, Schouten JA, ten Oever J. Current Practices and Opportunities for Outpatient Parenteral Antimicrobial Therapy in Hospitals: A National Cross-Sectional Survey. Antibiotics (Basel) 2022; 11:1343. [PMID: 36290001 PMCID: PMC9598700 DOI: 10.3390/antibiotics11101343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
This nationwide study assessed how outpatient parenteral antimicrobial therapy (OPAT) is organised by Dutch acute care hospitals, the barriers experienced, and how an OPAT program affects the way hospitals organised OPAT care. We systematically developed and administered a survey to all 71 Dutch acute care hospitals between November 2021 and February 2022. Analyses were primarily descriptive and included a comparison between hospitals with and without an OPAT program. Sixty of the 71 hospitals (84.5%) responded. Fifty-five (91.7%) performed OPAT, with a median number of 20.8 (interquartile range [IQR] 10.3-29.7) patients per 100 hospital beds per year. Of these 55 hospitals, 31 (56.4%) had selection criteria for OPAT and 34 (61.8%) had a protocol for laboratory follow-up. Sixteen hospitals (29.1%) offered self-administered OPAT (S-OPAT), with a median percentage of 5.0% of patients (IQR: 2.3%-10.0%) actually performing self-administration. Twenty-five hospitals (45.5%) had an OPAT-related outcome registration. The presence of an OPAT program (22 hospitals, 40.0%) was significantly associated with aspects of well-organised OPAT care. The most commonly experienced barriers to OPAT implementation were a lack of financial, administrative, and IT support and insufficient time of healthcare staff. Concluding, hospital-initiated OPAT is widely available in the Netherlands, but various aspects of well-organised OPAT care can be improved. Implementation of a team-based OPAT program can contribute to such improvements. The observed variation provides leads for further scientific research, guidelines, and practical implementation programs.
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Affiliation(s)
- Hester H. Stoorvogel
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Internal Medicine & IQ Healthcare, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
| | - Marlies E. J. L. Hulscher
- Radboud University Medical Center, Department of IQ Healthcare, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
| | - Heiman F. L. Wertheim
- Radboud University Medical Center, Department of Medical Microbiology, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
| | - Ed P. F. Yzerman
- ABR Zorgnetwerk Noord-Holland–Flevoland, 1105AZ Amsterdam, The Netherlands
| | - Maarten Scholing
- ABR Zorgnetwerk Noord-Holland–Flevoland, 1105AZ Amsterdam, The Netherlands
- OLVG Lab BV, 1091AC Amsterdam, The Netherlands
| | - Jeroen A. Schouten
- Radboud University Medical Center, Department of Intensive Care & IQ Healthcare, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
| | - Jaap ten Oever
- Radboud University Medical Center, Department of Internal Medicine, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
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22
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Mushtaq S, Garello P, Vickers A, Woodford N, Livermore DM. Activity of ertapenem/zidebactam (WCK 6777) against problem Enterobacterales. J Antimicrob Chemother 2022; 77:2772-2778. [PMID: 35972407 PMCID: PMC9384802 DOI: 10.1093/jac/dkac280] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Secondary healthcare will remain pressured for some years, both because SARS-CoV-2 will circulate as a nosocomial pathogen, and owing to backlogs of patients awaiting delayed elective procedures. These stresses will drive the use of Outpatient Parenteral Antibiotic Therapy (OPAT), which will need to cover increasingly resistant Gram-negative opportunists. We evaluated the activity of ertapenem/zidebactam, proposed for 2 + 2 g q24h administration. Materials and methods MICs were determined, by BSAC agar dilution, for 1632 Enterobacterales submitted to the UK national reference laboratory for investigation of antimicrobial resistance. Results Over 90% of Escherichia coli with AmpC, ESBLs, KPC, metallo- or OXA-48 carbapenemases were inhibited by ertapenem/zidebactam 1:1 at ertapenem’s current 0.5 mg/L breakpoint. For other major Enterobacterales, the proportions inhibited by ertapenem/zidebactam 1:1 at 0.5 mg/L were mostly 65% to 90% but were lower for Klebsiella pneumoniae/oxytoca with metallo- or OXA-48 β-lactamases. However, animal studies support an 8 mg/L breakpoint for ertapenem/zidebactam, based on a shortened T>MIC being needed compared with ertapenem alone. On this basis ertapenem/zidebactam would count as active against 90%–100% of isolates in all groups except K. pneumoniae/oxytoca with MBLs (±OXA-48), where MICs and percent susceptibility vary substantially even with inocula within the BSAC acceptable range. Conclusions Ertapenem/zidebactam has a proposed once-daily regimen well suited to OPAT. Even on highly conservative breakpoint projections, it has potential against MDR E. coli, including metallo-carbapenemase producers. If trial data sustain the 8 mg/L breakpoint indicated by animal experiments, its potential will extend widely across infections due to ESBL-, AmpC- and carbapenemase-producing Enterobacterales.
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Affiliation(s)
- Shazad Mushtaq
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Reference Services Division, United Kingdom Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Paolo Garello
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Reference Services Division, United Kingdom Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Anna Vickers
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Reference Services Division, United Kingdom Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Neil Woodford
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Reference Services Division, United Kingdom Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - David M Livermore
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Reference Services Division, United Kingdom Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK.,Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
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Rawson TM, Eigo T, Wilson R, Husson F, Dhillon R, Seddon O, Holmes A, Gilchrist M. Exploring patient acceptance of research within complex oral and IV outpatient parenteral antimicrobial therapy (COpAT) networks. JAC Antimicrob Resist 2022; 4:dlac087. [PMID: 36003076 PMCID: PMC9397122 DOI: 10.1093/jacamr/dlac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Timothy M Rawson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London , Hammersmith Campus, Du Cane Road , London W12 0NN, UK
- Centre for Antimicrobial Optimisation, Hammersmith Hospital, Imperial College London , Du Cane Road , London, W12 0NN, UK
| | - Theresa Eigo
- Imperial College Healthcare NHS Trust, Hammersmith Hospital , Du Cane Road , London W12 0HS, UK
| | - Richard Wilson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London , Hammersmith Campus, Du Cane Road , London W12 0NN, UK
- Centre for Antimicrobial Optimisation, Hammersmith Hospital, Imperial College London , Du Cane Road , London, W12 0NN, UK
- Imperial College Healthcare NHS Trust, Hammersmith Hospital , Du Cane Road , London W12 0HS, UK
| | - Fran Husson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London , Hammersmith Campus, Du Cane Road , London W12 0NN, UK
| | - Rishi Dhillon
- Public Health Wales Microbiology, University Hospital Wales , Heath Park , Cardiff, CF14 4XW, UK
| | - Owen Seddon
- Public Health Wales Microbiology, University Hospital Wales , Heath Park , Cardiff, CF14 4XW, UK
| | - Alison Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London , Hammersmith Campus, Du Cane Road , London W12 0NN, UK
- Centre for Antimicrobial Optimisation, Hammersmith Hospital, Imperial College London , Du Cane Road , London, W12 0NN, UK
| | - Mark Gilchrist
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London , Hammersmith Campus, Du Cane Road , London W12 0NN, UK
- Centre for Antimicrobial Optimisation, Hammersmith Hospital, Imperial College London , Du Cane Road , London, W12 0NN, UK
- Imperial College Healthcare NHS Trust, Hammersmith Hospital , Du Cane Road , London W12 0HS, UK
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